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52 A M i M A g A z i n e / / n o v e m b e r 1 6 , 2 0 1 1 / / 1 9 c h e s h va n , 5 7 7 2D dNursing Ho

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Death came unexpectedly or my mother. Only 10 days beoreher passing, on Thursday evening, October 21, 2010, wehad slowly shued together down the hallway, she pushinga wheelchair or support, its wheels squeaking, her handsclasping its black, grooved handgrips. Ater a ew dozen eet,she tired quickly and, with the help o a nurses aide, shesank back into the wheelchair.

I wheeled her back to her room in the nursing home, where shewas rehabbing or a ractured hip. We then made some small talk, dis-cussed her release date only a ew days away. At about 11:00 P.M.,aware o my exhaustion, she insisted I go home, kissing me goodnight. It would be the last time.

I remember when I was six, a mother o a classmate slipped on awet oor and banged her head. She then lapsed into a coma and died.That, I think, was the frst time I realized that parents are mortal, andthe thought gave me a twisting, sinking sensation in my stomach. I hadthat same nauseous eeling when, on Shabbos morning, my brother-in-law unexpectedly walked into the shul where I was davening, likea strange, out-o-place character in a dream. It being Shabbos, hehad walked the our miles rom the nursing home to tell me that mymother was taken to Beth Israel Hospital in Brooklyn. Mommy justeels a little uncomortable. Nothing serious, he had said.

Events quickly spun out o control. Motzei Shabbos, she lost con-sciousness. The diagnosis was a virulent orm o sepsis, an inectionthat had entered the bloodstream through the skin, inicting damageon her heart and kidneys. During the next week, the amily, takingturns, didnt budge rom her bedside, catching a ew minutes o sleephere and there on a hard vinyl chair. Quickly, we all learned what theuctuating LED readouts signifed on the various monitorspulse,oxygen levels, blood pressure. As I would doze o, the red segmentednumbers would be dancing in the blackness o my closed lids. Theollowing week, on a Monday aternoon, November 1, a lie that hadstarted in a rural town in Hungary, had survived as a child a harrow-ing escape through Nazi Germany and France, and had given birth tofve children, ended amid beeping and whirring medical monitoringmachines in an intensive care unit in Brooklyn.

When my mother had frst entered the hospital in August 2010, wehad not eared the hip surgerythe whole procedure to put in thepins didnt take more than 20 minutesbut rather, the possibility oinection. We had heard o too many horror stories about successuloperations on elderly patients ollowed by deadly pneumonia or otherinections. Our whole mindset was to get her out o there as quicklyas possible. Get her out o the hospital, my brain kept texting me.

When one day I saw her sniing with a balled-up tissue in her hand,I was terrifed that it was the precursor to some deadly inection. So

when we took my mother outof the hospital, we haD no iDeathat she was facing an even

bigger Danger...

by shlomo frieDmane

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54 A M i M A g A z i n e / / n o v e m b e r 1 6 , 2 0 1 1 / / 1 9 c h e s h va n , 5 7 7 2

to us, August 27, a cloudless day with a piercing blue sky, wasa day o good news. That day, she was judged well enough toleave the hospital to enter rehab. We grinned at each other, mybrother and I, about the act that we had navigated past whatwe thought was the most treacherous point o recovery. But un-known to us and to many who place their loved one in a nursinghome, either or long-term or short-term care, is that these acili-ties have extremely high rates o inection, and very oten harborvirulent inections that are potentially atal.Our mothers dreadulexperience with inection contracted in the acility shocked me,but during shiva, a number o riends and relatives shared similarstories o relatives who had unanticipated tragic experiences innursing homes, where inections had led to death or serious ill-ness. Their attitudes ranged rom indignation to resignation. Onewoman, who was disgusted with her mothers care in a nursinghome, told me she quit her job to be able to care or her parenthersel.

But i the scope and magnitude o nursing home inections

were mostly unknown to my amily and me, neither have theycaught the attention o researchers and the ederal governmentuntil recently. A resh body o research has uncovered an arrayo clues as to why nursing home inection rates are so highandwill likely get higher.

Ever since the mid-19th century, when Ignaz Semmelweissdiscovered that hand-washing saved mothers rom dying rompuerperal ever ater childbirth, one o the basics o inection con-trol has been hand-washing. But its that rudimentary procedurewhich, or a variety o reasons, researchers have ound is sorelylacking in nursing homes.

One o the researchers o the May Inection Controlstudy wasLaura Wagner, a proessor at New York Universitys School oNursing. With a youthul appearance, Wagner could easily bemistaken or one o her students. Photographs o Wagner withsome o her nursing home patients hung on her cubicle wall;piles o stapled research studies were stacked neatly on the oor.We are moving soon, she explained to me.

The modern nursing home concept, a a-

cility devoted mostly to elderly patients, is a

relatively recent phenomenon in the Ameri-

can health care system. Until the 1930s,

the elderly who didnt have the resources

to take care o themselves mostly lived in

government-sponsored or not-or-proit

acilities. For the most part, though, amily

members took care o their elderly parents

or relatives.

A dramatic unintended shit took place

with the passage o the Social Security

Act in 1935. The Old Age Assistance pro-

vision o the legislation granted a guar-

anteed income to those about the age o

65but there was a catch. Anyone living

in a government-sponsored residence was

ineligible to receive the unds. The rule pro-

duced a high demand or private homes

that would not make residents ineligible orthe OAA checks. By 1959, nursing homes

were overwhelmingly or-prot, with 15,530

or-prots and 1,429 non-prots. Today, or-

prots account or an estimated 70 percent

o all nursing homes. Government yet again

changed the complexion o nursing home

ownership with the Medicare and Medicaid

Acts o 1965. Medicaid mandated that gov-

ernment provide nursing home care or all

those without the means to do so, without

any time limit. The legislation made billions

available or an industry that had previously

operated on low prot margins. The new op-

portunities to make huge prots transormed

the or-prot nursing home sector into a

mega-business. Large companies, such as

Holiday Inn, began to orm nursing home

chains and oten initiated IPOs and foated

bonds, in the same capitalist tradition o any

other American corporation that desires ast

growth.The push to have unending Medic-

aid coverage or nursing home care in thelate 1950s and 1960s refected the seismic

economic shit taking place in American

households. The postwar American house-

hold was ast becoming one where hus-

band and wie both worked ull-time. With

both spouses out in the workplace it was no

longer possible to provide ull-time care or

elderly parents. Nursing homes became animportant component in sustaining the new

two wage-earner model.

Another change in the ace o nursing-

home ownership took place ater Congress

passed the Balanced Budget Act in 1997.

The legislation mandated Medicare to lower

costs by introducing a system that would

cap reimbursement payments to xed pay-

ments per care component.

Shortly, ater the change, ve o the larg-

est publicly-traded nursing home chains

went bankrupt, and private equity rms

began to buy up acilities. Private equity

rms now own our o the top 10 largest

nursing home chains. These top 10 chains

control 14 percent o all acilities in the U.S.

Todays nursing home patients mostly all

into two general categories long-term and

short-termeach refecting the two sources

o government-sponsored care. The lions

share o nursing home revenue, about 66

percent, comes rom Medicaid, but patient

eligibility or coverage is limited by state

income guidelines. Medicare will pay or pa-

tients care ater hospitalization without any

income restriction, but only up to a maxi-

mum o 100 days. Medicare covers most othe short-term patients, accounting or 10

percent o nursing home revenue.

w

ed mm

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1 9 c h e s h v a n , 5 7 7 2 / / n o v e m b e r 1 6 , 2 0 1 1 / / A M i M A g A z i n e 55

Wagner developed an interest in nursing home patients whileshe was a student nurse in Toronto in the late 1990s, taking careo an elderly patient who was kept immobilized in a chair re-straint. To the consternation o the administration, Wagner re-moved the restraint and began to encourage the patient to walk.When I came back a month later, she was walking on her own,

Wagner recalled.Restraints in nursing homes became the ocus o Wagners re-

search. We used to keep our elderly tied up, she said to me

straightorwardly. Her research, and that o others, proved that inmany cases restraints were not only unnecessary, but were beingused as a convenience or nursing home sta who didnt wantto be bothered with walking or checking on patients. When theSARS pandemic swept through Canada in 2003, Wagner sawfrsthand the positive eectiveness o extreme inection controlprocedure. The government imposed strict inection control pro-cedures in nursing homes, mandating that each acility hire adedicated inectious disease specialist. At Wagners acility, inec-

ad , 388,000 d

u.s. 1.7 d. t

d -

.

Ami Magazine would liketo express its condolences

to the amily o Reb Shlomo Zalman Bleier, zl,or their tragicand sudden loss and specifcally to his widow,

Mrs. Faigy Bleier ne Kauftheil.

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tions dropped dramatically. We had onewinter with no outbreaks.

Wagner decided to conduct the studybecause o her own experience and theederal governments nascent interest

in putting more emphasis on nursinghome research. We are just not doingthings about nursing homes, Wagnersaid. There is so much emphasis on hos-pitals, but nobody is looking at nursinghomes. Nobody is talking about itseeing that it is an issue. Nursing homeinection control has also caught theeye o the ederal government becauseo the recognition that winning the waron hospital inections requires fghtingbattles on multiple health care ronts,long-term care acilities being only oneo them. According to Dr. Vincent Qua-gliarello, Clinical Chie o Inectious Dis-eases at the Yale School o Medicine,multiple pathways o inection exist be-tween nursing homes and hospitals, pro-viding ree shuttle rides or bacteria totravel between acilities. Elderly patientscan pick up an inection in a hospitaland bring back a disease to the nursinghome, or they bring an inection to thehospital rom the nursing home, andthen return to the nursing home with anentirely new inection they picked up atthe hospital.

Whats also o concern to inectioncontrol specialists is the lack o data onthe vectors between hospitals and nurs-ing homes. A patient who becomes ill in anursing home and is sent to the hospitaland then dies there becomes a hospitalstatistic. There is no data integration be-tween health-care acilities so that ed-eral, state, or local health departmentscan holistically view the inection lie-cycle. Quagliarello hopes that PresidentObamas proposal or common elec-tronic medical records or all Americanswill build the inrastructure necessary or

health proessionals to track the sourceso inections. I hospitals and nursinghomes integrate their data, it would beeasier to trace which acilities are epi-centers or inections. Better inectioncontrol in nursing homes may soon bein their economic interest. The Agencyor Healthcare Quality and Research hasmade fghting healthcare-related inec-

tions a priority because o their extremecosts. The Centers or Medicare andMedicaid Service (CMS) no longer reim-burse hospitals or inections that theyconsider preventable; that same policy

might soon be put into place or nursinghomes.

Another researcher on the May Inec-tion Control study, Nicholas Castle, a pro-essor who teaches inection control at theUniversity o Pittsburgh Medical Center,wanted to apply his inection controlknowledge to nursing homes. Castle saidto himsel, Boy, Im teaching this in hos-pitals, yet I dont know much about it innursing homes. Based on research donein hospitals, Wagner and Castle had ahunch that nursing homes with the worstinection rates would also be the ones withthe lowest stafng levels. The researchersstudied thousand o nursing home recordsrom 2000 to 2007, or homes where theCenters or Medicare and Medicaid Ser-vice had given them an F-Tag 441 citation.F-Tag 441 citations are given to nursinghomes that do not meet the minimumrequirements in inection control, suchas proper hand-washing and disinectiontechniques. CMS penalizes nursing homeswith an excess o citations by withholdingMedicaid and Medicare reimbursements.

Inection control citations have been

on the rise nationwide, indicating a wors-ening problem. In 2004, CMS ound 15percent o nursing homes to be defcientin inection control. In 2009, the numberhad jumped to 30 percent. The numbersvary widely rom state to state. The worstoending state was Oklahoma, with 59percent o all its nursing homes ailingto provide basic inection control proce-dures. The state with the lowest percent-age, at 2.4 percent, was Rhode Island.New York was above the national averagewith 35.8 percent.

The study proved what the research-ers had suspected: Low stafng and highinection rates are highly correlated. Thehigher the stafng ratio per patient, thebetter the odds the acility will have alower inection rate.

fff

The trajectory o my mothers experi-

In the May issue o the American Journal

o Inection Control, a group o research-

ers published their ndings on the high

rate o nursing inections. According to

one estimate cited in the study, 388,000

nursing home patients die annually in the

United States o inection, out o a total

o 1.7 million residents. That translates to

more than one o out every ve residents

o a long-term acility who will succumb to

an inection. Inections are the cause o ap-

proximately 25 percent o all nursing home

patient hospitalization. The estimated cost

o treating these inections is anywhere be-

tween $673 million to $2 billion annually.

Another staggering statistic published in

the study: More than three million nursing

home residents will be stricken with an in-

ection during their stay, or more than two

inections a year per resident. The most

prevalent inections in nursing home are

pneumonia and urinary tract inections.

To be sure, nursing home researchers

caution that the high inection rates have to

be understood in the context o a popula-

tion that is much sicker than in years past.

Technology and medicine now keep pa-tients alive who, in earlier eras, would have

died. Because o advances in medicine,

it is common today or a patient to have

co-morbiditiesmultiple conditions where

each one is lie-threatening. Today, a nurs-

ing home patient could be stricken simulta-

neously with diabetes, heart disease, and

cancerall creating an immune system

that is vulnerable to inection. Because o

this, many nursing home patients would die

in the best o environments.

Nevertheless, the odds are that a resi-

dent living in a nursing home acility or one

year will have a 36 percent chance o con-

tracting pneumonia. That rate is a shock-

ing 10 times the rate or the same elderly

population living outside nursing homes.

So many nursing home patients contract

pneumonia that they account or almost 20

percent o all pneumonia hospitalizations

nationwide.

i

ud

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It isnt only understang that contributes

to improper inection control. It is also the

quality o the nursing home sta. The nurs-

ing home workers who interact daily with the

patients have dierent levels o expertise.

The most trained, the highest salaried (and

thereore the ewest per patient) are the reg-

istered nurses (RNs). The workers who have

the most interactions with the patients

moving, changing, eeding, bathing, and

medicating themare the certied nursing

assistants.

CNAs are low paid, earning hourly rates

hovering at around minimum wage. They

are also poorly trained, receiving certication

ater only 75 hours o training. Proper inec-

tion control is generally given only cursory

coverage during training, and there are only

three questions in the practice exam on the

topic.

With low pay, too many patients to care

or, and a nursing home population that is

more challenging than ever beore, CNAs

burn out quickly. Turnover is high; about

75 percent o CNAs in a acility will quit in

any given year. High turnover translates to

CNAs who have little experience in inection

control, and burdens the RNs with having to

continually retrain sta.

High turnover among CNAs also leads to

a loss in continuity o care. With large seg-

ments o the nursing home population su-

ering rom dementia, Alzheimers, or other

illnesses that make them unable to commu-

nicate, it is oten up to caregivers to detect

changes in behavior that clue them into the

onset o inections. That knowledge requires

knowing the patients nuances o behavior,

an observation highly unlikely when nursing

homes have such low sta retention rates.

t

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718. 232. 8466 | 516 . 568 . 4284201. 862. 0288

www.mendelmeyers.com

photography and video

The very best in fine

ence during the last ew months o her lie mirrors those o thousands o others whoenter long-term care acilities. She, like many others in nursing homes, had co-morbid-ities, that is to say, multiple health problems. The hip surgery was only the most recenthealth issue. She also had a pacemaker, a heart stent, high-blood pressure, and poorkidney unction. Looking back, our choices o where my mother could go to recuperate

rom the surgery were limited. She couldnt remain in the hospital, even i she wantedto, because Medicare wouldnt pay or it. She couldnt return home to be by hersel be-cause she couldnt walk, nor would private insurance or Medicare pay or the 24-hourcare necessary. In addition, she required physical therapy, using equipment unavailablein a home setting.The nursing home we ound met the cultural criteria that my motherneeded. It serviced mostly Jewish patients and was ully kosher. It also provided Jewishprayer services on Shabbos and Yom Tov. With Rosh Hashana, Yom Kippur, and Sukkoscoming up, she wanted to be able to attend shul. Although a large percentage o thepatients in the acility were Jewish, it would admit anyone who was eligible to stay,either through health insurance, Medicare, or Medicaid. Located only a ew eet romthe river, residents benefted during the summer rom the breezes wating through theopen windows. Seagulls soared, glided, and circled the nursing home, landing nearwhere residents sat outside on the ground-level porch. Looking let rom the windows inmy mothers room, on the 7th oor, we could see the wide panorama o a large sectiono Brooklyn.

Visually, this particular acility didnt have the look and eel o a nursing home: oorswere gleaming, and no antiseptic smell assaulted the nostrils. The lobby on the groundoor had several couches and love seats where residents and visitors socialized. Theood, my mother always used to marvel, was superb and ample. Tastes homemade, sheused to say. With its pastel-colored walls o alternating strips o light and dark beige, theacility had the appearance o an upscale apartment building, deying the image o the

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The revolving door o nursing home sta

also contributes to the widespread overuse

o antibiotics in nursing homes. Dr. David

Dosa, health services researcher and pro-

essor at Brown University, said the ollow-

ing scenario is common: Mrs. Smith has

dementia; she gets conused very easily. A

new nurse comes on, doesnt know Mrs.

Smith, and thinks Mrs. Smith is more con-

used than she should be. The nurse sus-

pects the conusion is due to a urinary tract

inection. She tells the doctor that she would

like to send out a urine sample to the lab.

Once that decision is made, oten what hap-

pens is a knee-jerk reach or the antibiotics.

Although antibiotics kill harmul bacteria,

their rampant use in nursing homes actually

creates the opportunity or more inections

to thrive, particularly C difcile, a bacterium

that can lead to diarrhea and sometimes

atal sepsis. To illustrate the harmulness o

unnecessary antibiotics, Dosa made this

analogy: Imagine you walk into a eld and

you poison all the grass, and only the weeds

are let. Bacteria are like weeds; they wont

do anything because they cant crowd out

the grass, but now you kill out all the grass.

Whats let?

Dosa studied antibiotics dosage in two

nursing home in Rhode Island during a six-

month period in 2008, and ound that in 41percent o the cases in which antibiotics

were prescribed, they were unnecessary. In

the cases where they were prescribed ac-

cording to medical guidelines, 72 percent

were given either the wrong dosage or told

to take it or the incorrect amount o time.

Urinary tracts inections, or UTIs, are a

scourge to nursing home patients. Oten a

UTI will be the start o an elderly patients

slippery slope to sepsis and then death. Dr.

Seth Lapin, a gastroenterologist in Brooklyn

or the past 15 years, has treated hundreds

o nursing home patients. He blames many

nursing-home UTIs on unnecessary blad-

der catheterization, where a tube is inserted

into the bladder and then a bag collects the

urine. I nd that a lot o patients have them,

even though they dont need them, he said.

Its easier or the sta to leave the catheter

in than to change the patient. Lapin esti-

mates that a majority o catheterizations are

not medically justied.

Dda

h jd , .p , . r,, d - dd .depersonalized setting so associated with nursing homes. More-over, the home was convenient, within several miles o wherethree o her children lived.

My mother wound up in a nursing acility only because o thenew structure o our healthcare system. Until the 1990s, homeswould have residents who were relatively healthy, with some asyoung as in their 60s. Today, long-term care acilities house awide range o demographics with a host o illnesses: middle-agedor otherwise healthy seniors undergoing rehab; Alzheimers anddementia patients; patients in need o complex intervention pro-tocols like IV and dialysis; and those who are terminally ill.

The mix has created an inection-control nightmare. Whereashospitals inherently have a setting where patients, mostly con-fned to their rooms or beds, do not mingle with other patients,nursing homes have more o a communal atmosphere. Patients

eat together, socialize together, andrehab together, creating an environ-ment ripe or the spread o inection. Italso exposes mostly healthy patients toinections that have colonized in muchsicker residents.

The primary reason behind thechanging makeup o the nursing homepopulation is exploding healthcarecosts o hospitalization. Private insur-ance companies, Medicaid, and Medi-care are all anxious or patients to leavethe expensive confnes o hospital care,where a bed can cost thousands o dol-lars a day. Paying or a patient in a bedin a nursing home is ar cheaper than

in a hospital. Hospitals have mostly jettisoned their role as acili-ties or recuperation, ocusing primarily on acute care. Patientsleave hospitals sick, but not sick enough to stay. Recuperation,rehab, and other sub-acute care have been ooaded to nursinghomes.

Sharing the experience o many nursing home patients, mymother contracted pneumonia during the second week o Sep-tember. We didnt want to scare her, so we told her she hadbronchitis. Although her lungs were ofcially clear two weekslater, she was still coughing the last time I saw her at the home, amonth and a hal later.

fff

Could my mothers death have been prevented with better

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Why does understang lead to more in-

ections? Proessor Nicholas Castle thinks

the answer is simple: the ewer health care

workers there are the more hurried you

are, the less likely you are to ollow inec-

tion control procedures, he explained. The

most basic procedure to prevent inections

is hand-washing, and its there that nurs-

ing homes commonly ail: In general, hand-

washing compliance is dismal. Mark Loeb,

a proessor o Public Health at McMasters

University in Toronto, studied several nurs-

ing homes in 1999, monitoring hundreds o

instances where hand disinection should

have been done but wasnt. The sta in the

nursing homes that Loeb studied washed

their hands only 15 percent o the time ater

perorming tasks like moving or dressing

a patient. Loeb doesnt believe much has

changed since his original study. I dont

think compliance is more than 20 percent,

he said. Understang at long-term care

acilitiesand how it contributes to poor

carehas been on the radar screen o nurs-

ing home researchers or at least a decade.

Its what many researchers see as the smok-ing gun o nursing home inections. Char-

lene Harrington, a proessor at the University

o Southern Caliornia, said, We have done

tons o studies, and every single one shows

that nursing homes are understaed. Nurs-

ing homes inections are worse than hos-

pitals because they have hal the sta that

hospitals have. Nursing homes are grossly

understaed.

We know rom ederal studies that the

minimum stang should be 4.1 hours per

resident per day, but the average stang

level is much lower. The biggest single prob-

lem is inadequate stang. Harrington thinksthat the problem o poor inection control is

so intractable because o the dicult bal-

ance or institutions that, on the one hand,

have to provide prots to shareholders and

owners and, on the other, are expected to

provide the best care possible to their resi-

dents. In Harringtons view, too oten poor

inection control is a symptom o the pursuit

o large prots. Most nursing homes are

businesses; more sta slices into their prot

margin. That prot margin can be signicant.

In 2008, two o the top 10 nursing homes

had prot margins o 15 to 18 percent, pro-

itability comparable to such corporate behe-

moths as General Electric or Alcoa in a good

year. Thats somewhat startling when most

nursing home income is derived rom ederal

and state governments.

Nursing homes generally dont make

money on Medicaid patients. In act, with

a maximum reimbursement rate o about

$270 a day, nursing homes oten lose

money on Medicaid patients. Where nursing

homes earn a prot is on Medicare patients,

where reimbursements can reach $700 to

$800 a day. Medicare patients have larger

reimbursements because the patients are

supposed to be sicker, and thereore require

more sta per patient.

But the problem, according to Harrington,

is that nursing homes take the Medicare re-

imbursements, but dont provide the care.

They get paid more by Medicare, but then

they dont put the stang in. Medicarehasnt set any accountability requirements

or the nursing homes. They are getting

away with this because the ederal govern-

ment has no minimum stang standards.

Overall, the most understaed acilities

are the or-prots. The non-prots do hire

more people; the or-prots cut stang to

the bone, Harrington said. Harrington and

other researchers published a study that

looked at state inspections o thousands o

nursing homes, nding that or-prot acili-

ties averaged 47 percent more unsatisac-

tory citations than non-prots.

A 2007 study o the most-cited nursing

homes by the Government Accounting Oce

bolsters Harringtons contentions. The worst

perorming acilities in the nation, the GAO

concluded, were more likely to be or-prot

and part o a chain and have more beds and

residents. In addition, they had an average

o almost 24 percent ewer registered nurse

hours per resident, per day.

w

nk

inection control at a dierent acility?Its difcult to say, but i we had knownhow prevalent these deadly inections are,and the variables that may make a acilityless likely to spread them, we might havemade a dierent choice.

One important source o inorma-tion to which we were oblivious wasthe nursing-home comparison website,which makes some nursing home inec-tion data more transparent. All acilitiesthat receive Medicaid or Medicare reim-bursements are searchable. Accordingto the site, my mothers acility had thehighest overall rating a nursing homecan have, fve stars, a distinction givento it because o its outstanding record oinspections.

But a stellar record o inspectionsdoesnt guarantee positive outcomes orpatients. A deeper dig into the data re-veals that despite the high overall rating,my mothers acility had the potential tobe a dangerous place or its residents. In2009, 14 percent o its residents devel-oped urinary tract inections; one outo every three long-term patients de-veloped bedsores, more than triple thenational average; and 70 percent lostbladder or bowel control. In these qual-ity measures, the acility only receiveda two-star rating. The site also indicateswhether an institution is non-proft or

or-proft. The acility in question is a or-proft institution. Its a privately ownedpartnership, so its fnances are not opento the public.

Although research keeps indicatingthat non-profts are superior when itcomes to inection control, structuralchanges in how we care or our elderlyare unlikely to take place anytime soon.

As Proessor Charlene Harrington saidwhen she presented her research fnd-ings beore Congress (see sidebar), Theyare just not interested in doing anythingabout it because they say, These are pri-vate companies. We cant tell them howto run the company.

Harrington maintains that at the hearto the high nursing home inection rateis a cultural attitude o, We dont like tothink about people getting old. We dontlike to talk about it. When they go inthere, we just like to write them o.

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52-59_Ami045.Nursing (1)